Predicting Recovery and Outcome after Pediatric Stroke: Results from the International Pediatric Stroke Study.

Felling, Ryan J; Rafay, Mubeen F; Bernard, Timothy J; Carpenter, Jessica L; Dlamini, Nomazulu; Hassanein, Sahar M A; Jordan, Lori C; Noetzel, Michael J; Rivkin, Michael J; Shapiro, Kevin A; Slim, Mahmoud; deVeber, Gabrielle (2020). Predicting Recovery and Outcome after Pediatric Stroke: Results from the International Pediatric Stroke Study. Annals of neurology, 87(6), pp. 840-852. Wiley-Blackwell 10.1002/ana.25718

[img] Text
ana.25718.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (659kB)

OBJECTIVE

To characterize predictors of recovery and outcome following pediatric arterial ischemic stroke, hypothesizing that age influences recovery after stroke.

METHODS

We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with 2-year follow-up after arterial ischemic stroke. Outcomes were defined at discharge by clinician grading and at 2 years by the Pediatric Stroke Outcome Measure. Demographic, clinical, and radiologic outcome predictors were examined. We defined changes in outcome from discharge to 2 years as recovery (improved outcome), emerging deficit (worse outcome), or no change.

RESULTS

Our population consisted of 587 patients, including 174 with neonatal stroke and 413 with childhood stroke, with recurrent stroke in 8.2% of childhood patients. Moderate to severe neurological impairment was present in 9.4% of neonates versus 48.8% of children at discharge compared to 8.0% versus 24.7% after 2 years. Predictors of poor outcome included age between 28 days and 1 year (compared to neonates, odds ratio [OR] = 3.58, p < 0.05), underlying chronic disorder (OR = 2.23, p < 0.05), and involvement of both small and large vascular territories (OR = 2.84, p < 0.05). Recovery patterns differed, with emerging deficits more common in children <1 year of age (p < 0.05).

INTERPRETATION

Outcomes after pediatric stroke are generally favorable, but moderate to severe neurological impairments are still common. Age between 28 days and 1 year appears to be a particularly vulnerable period. Understanding the timing and predictors of recovery will allow us to better counsel families and target therapies to improve outcomes after pediatric stroke. ANN NEUROL 2020;87:840-852.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Neuropaediatrics

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1531-8249

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Anette van Dorland

Date Deposited:

19 Jan 2021 09:03

Last Modified:

04 Aug 2022 14:42

Publisher DOI:

10.1002/ana.25718

PubMed ID:

32215969

Additional Information:

International Pediatric Stroke Study Group: Prof Dr. Steinlin

BORIS DOI:

10.48350/151401

URI:

https://boris.unibe.ch/id/eprint/151401

Actions (login required)

Edit item Edit item
Provide Feedback